Posts Tagged lower limb

[Abstract + References] Do powered over-ground lower limb robotic exoskeletons affect outcomes in the rehabilitation of people with acquired brain injury?

Abstract

Purpose: To assess the effects of lower limb robotic exoskeletons on outcomes in the rehabilitation of people with acquired brain injury.

Materials and methods: A systematic review of seven electronic databases was conducted. The primary outcome of interest was neuromuscular function. Secondary outcomes included quality of life, mood, acceptability and safety. Studies were assessed for methodological quality and recommendations were made using the GRADE system.

Results: Of 2469 identified studies, 13 (n = 322) were included in the review. Five contained data suitable for meta-analysis. When the data were pooled, there were no differences between exoskeleton and control for 6-Minute Walk Test, Timed Up and Go or 10-Meter Walk Test. Berg Balance Scale outcomes were significantly better in controls (MD = 2.74, CI = 1.12–4.36, p = 0.0009). There were no severe adverse events but drop-outs were 11.5% (n = 37). No studies reported the effect of robotic therapy on quality of life or mood. Methodological quality was on average fair (15.6/27 on Downs and Black Scale).

Conclusions: Only small numbers of people with acquired brain injury had data suitable for analysis. The available data suggests no more benefit for gait or balance with robotic therapy than conventional therapy. However, some important outcomes have not been studied and further well-conducted research is needed to determine whether such devices offer benefit over conventional therapy, in particular subgroups of those with acquired brain injury.

  • Implications for Rehabilitation
  • There is adequate evidence to recommend that powered over-ground lower limb robotic exoskeletons should not be used clinically in those with ABI, and that use should be restricted to research.
  • Further research (controlled trials) with dependent ambulators is recommended.
  • Research of other outcomes such as acceptability, spasticity, sitting posture, cardiorespiratory and psychological function, should be considered.

References

Source: https://doi.org/10.1080/17483107.2018.1499137

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[Abstract] GAMEREHAB@HOME: a new engineering system using serious game and multi-sensor fusion for functional rehabilitation at home

Abstract

Biomedical connected objects like kinematic sensors have been commonly used for patient monitoring in many clinical applications. Moreover, serious games have become widely used to improve patients‘ motivation during functional rehabilitation.
In this work, we developed and evaluated a new engineering system as a solution for functional rehabilitation at home. A multi-sensor fusion between Kinect camera and inertial sensors was developed to animate a 3D avatar during rehabilitation and to estimate kinematic data of different joints for clinical monitoring.
Two serious game scenarios were designed for upper and lower limb rehabilitation. The developed system was evaluated through patient kinematic data and a questionnaire-based approach with a panel of eight post-stroke patients and four clinical experts. The evaluation of the system showed that multi-sensor fusion provides useful data for clinical follow-up. The virtual game scenarios lead to a high level of immersion for patients. Feedbacks from clinical experts concerning the system’s GUIs and the clinical relevance of the acquired data for each rehabilitation session are positive. The developed system paves the way to deploy recent technologies, such as multi-sensor fusion and serious games, as a solution for home-based rehabilitation, which can optimize the benefit of the involved patients and medical experts.

via GAMEREHAB@HOME: a new engineering system using serious game and multi-sensor fusion for functional rehabilitation at home – IEEE Journals & Magazine

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[Abstract] Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial

 

BACKGROUND: Lower limb support ability is important for steady and efficient mobility, but previous data commonly involved training during double stance positions, with or without external feedback, using a complex and costly machine.
AIM: To compare the effects of stepping training with or without external feedback in relation to the lower limb support ability of the affected limb on the functional ability necessary for independence in individuals with stroke.
DESIGN: A single-blinded, randomised controlled trial.
SETTING: Tertiary rehabilitation centres.
POPULATION: Ambulatory participants with stroke who walked independently over at least 10 meters with or without walking devices.
METHODS: Thirty-six participants were randomly arranged to be involved in a program of stepping training with or without external feedback related to the lower limb support ability of the affected limb (18 participants/group) for 30 minutes, followed by overground walking training for 10 minutes, 5 days/week over 4 weeks. The outcomes, including the lower limb support ability of the affected legs during stepping, functional ability and spatial walking data, were assessed prior to training, immediately after the first training session, and after 2- and 4- week training.
RESULTS: Participants demonstrated significant improvement in the amount of lower limb support ability, immediately after the first training with external feedback. Then, these participants showed further improvement in both the amount and duration of lower limb support ability, as well as the timed up and go data after 2 and 4 weeks of training (p < 0.05). This improvement was not found following control training.
CONCLUSIONS: The external feedback relating to lower limb support ability during stepping training effectively improved the movement stability and complex motor activity of ambulatory individuals with stroke who had long post-stroke time (approximately 3 years).
CLINICAL REHABILITATION IMPACT: Stepping training protocols and feedback can be easily applied in various settings using the amount of body-weight from an upright digital bathroom scale. Thus, the findings offer an alternative rehabilitation strategy for clinical, community and home-based settings for stroke individuals.

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via Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2019 Oct 15 – Minerva Medica – Journals

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[Abstract] Ergometer training in stroke rehabilitation: systematic review and meta-analysis

Abstract

Objective

Ergometer training is routinely used in stroke rehabilitation. How robust is the evidence of its effects?

Data source

The PubMed database and PEDro database were reviewed prior to 22/01/2019.

Study selection

Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected.

Data extraction

Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.

Data synthesis

A total of 28 studies (including 1115 stroke subjects) were included. The data indicates that

(1) ergometer training leads to a significant improvement of walking ability, cardiorespiratory fitness, motor function and muscular force of lower limbs, balance and postural control, spasticity, cognitive abilities, as well as the brain’s resistance to damage and degeneration,

(2) neuromuscular functional electrical stimulation assisted ergometer training is more efficient than ergometer training alone,

(3) high-intensity ergometer training is more efficient that low-intensity ergometer training, and

(4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability.

Conclusion

Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in stroke subjects.

via Ergometer training in stroke rehabilitation: systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] A Method for Self-Service Rehabilitation Training of Human Lower Limbs – IEEE Conference Publication

Abstract

Recently, rehabilitation robot technologies have been paid more attention by the researchers in the fields of rehabilitation medicine engineering and robotics. To assist active rehabilitation of patients with unilateral lower extremity injury, we propose a new self-service rehabilitation training method in which the injured lower limbs are controlled by using the contralateral healthy upper ones. First, the movement data of upper and lower limbs of a healthy person in normal walk are acquired by gait measurement experiments. Second, the eigenvectors of upper and lower limb movements in a cycle are extracted in turn. Third, the linear relationship between the movement of upper and lower limbs is identified using the least squares method. Finally, the results of simulation experiments show that the established linear mapping can achieve good accuracy and adaptability, and the self-service rehabilitation training method is effective.

via A Method for Self-Service Rehabilitation Training of Human Lower Limbs – IEEE Conference Publication

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[Abstract] Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke – a retrospective case-matched study.

Abstract

BACKGROUND:

Functional electrical stimulation (FES) plus body weight-supported treadmill training (BWSTT) provide effective gait training for poststroke patients with abnormal gait. These features promote a successful active motor relearning of ambulation in stroke survivors.

AIM:

This is a retrospective study to assess the effect of FES plus BWSTT for gait rehabilitation in patients poststroke.

DESIGN:

A retrospective case-matched study.

SETTING:

Participants were recruited from a rehabilitation department in an acute university-affiliated hospital.

POPULATION:

Ninety patients poststroke from Yue Bei People’s Hospital underwent BWSTT (A: control group) were compared to an equal number of cross-matched patients who received FES plus BWSTT (B: FES plus BWSTT group).

METHODS:

While B group received FES for 45 minutes plus BSWTT for 30 minutes in the program, group A received time-matched BWSTT alone. The walking speed, step length, step cadence, Fugl-Meyer lower-limb scale (LL-FMA), composite spasticity scale (CSS), 10-Meter Walk Test (10MWT), Tinetti Balance Test (TBT) and nerve physiology testing were collected before and after intervention.

RESULTS:

One hundred and eighty patients with poststroke abnormal gait were chosen. There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between baseline and post-intervention (P<0.05). There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between two groups at the end of the eighth week (P<0.05), but not at baseline (P>0.05). In comparison with group A, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the group B (P < 0.05). No adverse events occurred during the study.

CONCLUSIONS:

This study suggests that FES plus BWSTT could be more effective than BWSTT alone in the improvement of gait, balance, spasticity, and function of the lower limb in patients poststroke.

CLINICAL REHABILITATION IMPACT:

Introduce effective rehabilitation strategies for poststroke patients with abnormal gait.

 

via Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke-a ret… – PubMed – NCBI

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[WEB PAGE] Dysport is Now Approved for Upper Limb Spasticity as Well

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The United States Food and Drug Administration (FDA) has expanded the use of Dysport (abobotulinumtoxinA) for injection to include the treatment of upper limb spasticity in children two years of age and older, excluding spasticity caused by cerebral palsy (CP), Ipsen Biopharmaceuticals, an affiliate of Ipsen, announces in a news release.

This approval makes Dysport the first botulinum toxin approved by the FDA for both pediatric spasticity indications, following the previous approval to treat children with lower limb spasticity aged two and older received in July 2016.

“For physicians, it is reassuring to have a botulinum toxin treatment in Dysport which demonstrated sustained symptom relief for spasticity, which can be physically challenging for children,” says Ann Tilton, MD, study investigator and Professor of Clinical Neurology at the Louisiana State University Health Sciences Center New Orleans, in the release.

“This FDA decision for Dysport means we now have an approved therapy to offer children and adolescents seeking improvements in mobility in both upper and lower limbs.”

The approval is based on a Phase 3 study with children aged two to 17 years old being treated for upper limb spasticity. Due to Orphan Drug Exclusivity, this approval excludes use in children with upper limb spasticity caused by CP. Dysport demonstrated statistically significant improvements from baseline at Week 6 with doses of 8 Units/kg and 16 Units/kg vs. 2 Units/kg, as measured by the Modified Ashworth Scale (MAS) in the elbow or wrist flexors.

Dysport demonstrated a reduction in spasticity symptoms through 12 weeks for most children for both upper and lower limbs. In the upper limb study, a majority of patients were retreated between 16-28 weeks; however, some patients had a longer duration of response (ie, 34 weeks or more). The most frequent adverse reactions observed were upper respiratory tract infection and pharyngitis, the release explains.

“This approval is a testament to Ipsen’s legacy in neurotoxin research and continued commitment to advancing patient care,” states Kimberly Baldwin, Vice President, Franchise Head, Neuroscience Business Unit, Ipsen. “We believe the data for both pediatric upper and lower limb spasticity underscore the role of Dysport as an important treatment option for patients seeking long-lasting spasticity symptom relief.”

For more information, visit Ipsen.

[Source(s): Ipsen, Business Wire]

 

via Dysport is Now Approved for Upper Limb Spasticity as Well – Rehab Managment

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[Abstract + References] A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation

Abstract

Recent investigations have proposed brain computer interfaces combined with functional electrical stimulation as a novel approach for upper limb motor recovery. These systems could detect motor intention movement as a power decrease of the sensorimotor rhythms in the electroencephalography signal, even in people with damaged brain cortex. However, these systems use a large number of electrodes and wired communication to be employed for gait rehabilitation. In this paper, the design and development of a wireless brain computer interface combined with functional electrical stimulation aimed at lower limb motor recovery is presented. The design requirements also account the dynamic of a rehabilitation therapy by allowing the therapist to adapt the system during the session. A preliminary evaluation of the system in a subject with right lower limb motor impairment due to multiple sclerosis was conducted and as a performance metric, the true positive rate was computed. The developed system evidenced a robust wireless communication and was able to detect lower limb motor intention. The mean of the performance metric was 75%. The results encouraged the possibility of testing the developed system in a gait rehabilitation clinical study.

References

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    Pfurtscheller, G., Mcfarland, D.: BCIs that use sensorimotor rhythms. In: Wolpaw, J.R., Wolpaw, E. (eds.) Brain-Computer Interfaces: Principles and Practice, pp. 227–240. Oxford University Press (2012)Google Scholar
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    Carrere, L.C., Tabernig, C.B.: Detection of foot motor imagery using the coefficient of determination for neurorehabilitation based on BCI technology. IFMBE Proc. 49, 944–947 (2015).  https://doi.org/10.1007/978-3-319-13117-7_239CrossRefGoogle Scholar
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    Do, A.H., Wang, P.T., King, C.E., Schombs, A., Cramer, S.C., Nenadic, Z.: Brain-computer interface controlled functional electrical stimulation device for foot drop due to stroke, pp. 6414–6417 (2012)Google Scholar
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    Biasiucci, A., Leeb, R., Iturrate, I., Perdikis, S., Al-Khodairy, A., Corbet, T., Schnider, A., Schmidlin, T., Zhang, H., Bassolino, M., Viceic, D., Vuadens, P., Guggisberg, A.G., Millán, J.D.R.: Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nat. Commun. 9, 1–13 (2018).  https://doi.org/10.1038/s41467-018-04673-zCrossRefGoogle Scholar
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    g.Nautilus wireless biosignal acquisition Homepage. http://www.gtec.at/Products/Hardware-and-Accessories/g.Nautilus-Specs-Features
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    Emotiv EpocFlex flexible wireless EEG system Homepage. https://www.emotiv.com/epoc-flex/
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    Vuckovic, A., Wallace, L., Allan, D.: Hybrid brain-computer interface and functional electrical stimulation for sensorimotor training in participants with tetraplegia: a proof-of-concept study. J. Neurol. Phys. Ther. 39, 3–14 (2015)CrossRefGoogle Scholar
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    McCrimmon, C.M., Fu, J.L., Wang, M., Lopes, L.S., Wang, P.T., Karimi-Bidhendi, A., Liu, C.Y., Heydari, P., Nenadic, Z., Do, A.H.: Performance assessment of a custom, portable, and low-cost brain-computer interface platform. IEEE Trans. Biomed. Eng. 64, 2313–2320 (2017).  https://doi.org/10.1109/TBME.2017.2667579CrossRefGoogle Scholar

via A Wireless BCI-FES Based on Motor Intent for Lower Limb Rehabilitation | SpringerLink

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[Abstract] Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation

Abstract

Stroke survivors often suffer from a permanent or partial disability that restricts the movement of the hands, arms and/or legs. To help patients recover, rehabilitation should be at an earlier stage of the injury. Without motivation, it would be challenging for patients to successfully engage in the recovery process which can sometimes be painful of inconvenient. The application of wearable devices, games and Internet-of-Things (IoT) can create a motivating atmosphere to facilitate the rehabilitation process of patients while enabling remote monitoring of their health and progress. This paper presents the design and implementation of a rehabilitation system for aimed at helping stroke patients suffering from upper limb disability that exploits IoT by integrating gaming and wearable technology.

via Design and Implementation of a Wearable Device for Motivating Patients With Upper and/or Lower Limb Disability Via Gaming and Home Rehabilitation – IEEE Conference Publication

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